Monday, February 28, 2011

I have a friend named Ed. Ed is a lovely person. He's been called the James Bond of Weird; I prefer to think of him as The Silly Ninja. He loves his wife and cats and gadgets; in fact, it was Ed and Anne who donated the nifty electronic write on/wipe off board with which I communicated after my surgery. Ed and his lovely wife are half of the Fearsome Foursome of Friends with whom I love to spend my time.

Ed will be shaving his head at a cheesy chain restaurant on the 20th of March in order to raise money to fight childhood cancers. Now, I have this to say about that:

Leaving aside how scary (or not) Ed might look bald, childhood cancer is a fucking scary thing. See, cancer normally happens when your DNA gets worn out and breaks or replicates itself strangely, which is what happens over a lifetime of exposure to things that can fuck up DNA.

Kids' cancers happen without that lifetime of exposure. Kids don't get exposed to forty years' worth of sunlight, or smoked meat, or HPV, or any of the other thousand things that can cause your DNA to break and you to end up talking funny without a plastic part shoved up your mouth.

In short, childhood cancer is scary. Rare, but scary--mostly because it tends to be really aggressive, no matter the type.

In the 1950's, acute leukemia meant a kid died in a few days. Now those kids are being cured and living normal lives, thanks to the efforts of people who researched and sweated and experimented in order to find a cure for acute childhood leukemias. That research takes money, plain and simple. (It also takes weirdos like Ed who are willing to shave their heads, but that's just another way of raising dough.)

Thus, at the end of February, I'm asking you guys to do this: click on the link above. Read about St. Baldrick's. Decide, if it's something that speaks to you, what amount you'd like to donate. If you'd like to pledge especially to my pal Ed, I'll happily put you in touch with his pledge page once I've cleared it with him (because, um, those words just came out of my fingers and I have no clue if he'd be okay with that, but if he's not then well, we'll figure it out somehow).

If you feel particularly adventurous, shave your own head. I would do it, but I'm already too close to bald for it to make a difference. Plus, I sunburn.

There you go: The Head Nurse Monthly Moneybeg for February 2011!

Have at it, peeps. You've changed at least four lives so far. Let's see how many more we all can change together with this.

Thursday, February 24, 2011

My week totally blew up in my face: my prosthetic broke (just a wire; I'd apparently been biting on it because it wasn't fitted exactly right), Libya and NZ are happening, and Der Alter Jo's pal Mike has been diagnosed with cancer.

That last makes me both sad and sick to my stomach. Mike is homeless. He lives in a carport, basically, near D.A.J.'s house; she got to know him because she's a decent human being and because they both like cats.

Mike's cancer is probably really, really advanced. He's at County Giganto right now with lumps popping out all over and a whole lot of pain from a pathological fracture. And, since he has no money and no home and no resources (thanks, Governor Goodhair!), he'll probably die in pain and alone and without dignity. Hospice care in the homeless shelter doesn't exist, as far as I know.

Plus, he's got TB, which means...well, honestly, I don't know what it means. I don't know where he'll end up or what will happen to his pet cat or what on earth people in his situation do.

I wish I ruled the Universe. Things like this wouldn't happen. People would still be afraid and hurting, because you can't make that go away, but at least they wouldn't be worried about being turned out to die on the motherfucking street because the county cut funds for indigent health care.

Sunday, February 20, 2011

Max doesn't like going to the vet. He's okay once we get there, but he kind of hates the car ride, as he wants to protect me from everything that he sees coming toward us. He gets overstimulated.

I took him to the vet the other day by mistake, thinking it was time for his checkup. He's not due until July. Since we were there, though, I asked them to please cut his nails. He doesn't mind having his nails clipped at home, but he tends to seek out and grab the nail clippers, then smuggle them outside in his copious cheek-pouches and bury them. So I'm short a pair of clippers right now. Note that "doesn't mind" for Max equals "doesn't try to rip the throat out of whoever's doing whatever". He bitches and shifts his feet, but he's not actually homocidal.

The mani-pedi took longer than usual. Max reappeared after about fifteen minutes with a tech at the other end of the leash, and I asked if there'd been a problem.

"Oh, no!" The tech was grinning. "He's a perfect gentleman. So sweet! (Aren't you a good boy, Max?) It's just that, after I finished his back paws and before I started on his front paws, he fell over on top of me and asked for belly-rubs, so I had to rub his belly and snuggle him."

This is my resolution: to behave more like Max in the next week. If something I normally dislike but endure happens to me, I promise to create the opportunity for belly-rubs.

You guys are going to cost me my job, my sanity, and my freedom, not necessarily in that order. What's going to happen is a mass slaughter of people I normally like and respect and depend upon, and then I'll get arrested and from then on things will suck.

But! There's a chance to turn this boat around, to make sure that you all keep your collective and individual lives and that I keep my happy-go-lucky personality. Everything rests on these four littleish words:

Neuro Critical Care Unit.

That's where I work (and what I kind of by default, without really wanting to, find myself running sometimes).

In order for you, beloved Medicos, to admit a patient to the NCCU, they have to meet two criteria: they have to have a Neurological Problem and need Critical Care.

That means that the dude who's been stable neurologically for two weeks but who needs frequent suctioning does not qualify. Frequent suctioning is not a Critical Care Function. Likewise, if you feel like your completely intact, rock-stable patient doesn't get enough attention (I wish I were making this up) on the acute-care floor, you can't just transfer them to the NCCU so that they'll get their little paddy-paw held.

I know that seems unfair. After all, we have three whole beds in our NCCU, and you want your patient to be taken care of! The thing is, though, that those beds are generally reserved for people who need

Neuro

Critical

Care.

For instance, if somebody has a stroke as a complication of surgery, that person would be transferred to the NCCU. If somebody else had a dimunition of mental status after anesthesia, off they'd go to the NCCU for observation. If a third person had an aneurysm coiled or glued or otherwise dealt with in a minimally-invasive manner, they'd come to us. Most of all, if some poor sot came into the emergency department at Holy Kamole with an occlusive stroke, they'd be transferred, hospital to hospital, for what's known as "definitive management".

"Definitive management" means that we do Neurological Critical Care.

And Neurological Critical Care does not mean--and I want to stress this again--scheduled, every-three-hour nasal-tracheal suctioning for somebody who's otherwise a candidate for a floor bed. It does not mean transferring a walkie-talkie patient to the unit because you felt the nurses on another floor "weren't seeing him enough". Level of care is not an indication for our unit. Level of acuity is.

Unfortunately, and I'm looking at you, Medicos, anybody who needs Neuro Critical Care this weekend and into the start of next week will be, in the words of Queen Victoria, shit out of luck. Because you've filled my three! whole! beds! with your personal pets, thus leaving no

Neuro

Critical

Care

beds for people who might actually need them. Yeah, I suppose we could send people to the surgical critical care unit, but they're not specialists on strokes. We are.

And we can't exactly do a whole lot of transfers in and out, to the floor or the SCCU, because there are no open beds in the hospital.

I explained this all to you, and even got a little short-tempered (and I normally love you guys and gals, really). The house manager explained it to you. The charge nurses of at least two units explained it to you. And still, when I left yesterday, I had a unit full of people who did not need

Neuro

Critical

Care.

Poor Jo (Der Alter Jo) had her dinner interrupted last night when I called her from the car to vent. Doctors mine, the first words out of my mouth at the end of the day should not ever have to include reflections on your personality or your parentage, followed by the phrase "Good holy God I need a new job."

Please do not do this any more. Admit the people to the Neuro Critical Care Unit who are both Neuro and Critical. Do not admit the people who are not. I don't know how to make that any simpler for you. Please do not make me try; "simpler" at this point might include "pounding it into your head with a half-roasted ham."

I was snippy to a coworker the other day. What I was snippy about isn't important (it was patient placement in rooms, which turns into the three geese and the fox and the rowboat and the deaf boatman if you let it), and it wasn't an emergency (except that we had four patients to put into three beds and one of them was male and one was female and the third I don't remember except that it was a sex that made everything much more difficult) and, well, I was snippy.

Which ought to have been my clue: When Jo Is Snippy, Jo Is Wrong.

Except for last week. When the weird guy showed up on the unit, without an ID, and leading a crowd of residents.

He asked me a reasonable question, which I answered in a reasonable fashion. And then The Weird Guy said this:

"That's just the sort of response I would expect....from a nurse."

And I, God help me, said, "Oh! That's the sort of comment I would expect....from an ASSHOLE."

The Weird Guy? With no ID?

Was the new chairman of the neurology department.

Yeah.

Never mind that he was a thundering, galloping dick who deserved what he got; I mouthed off to the new chairman of the department.

However, he's been quite nice to me since then, even asking my opinion of a particularly difficult case.

The Other Nurse Who Works With The Chairman is of the opinion that he's an Asperger's Bully--you know, the sort that uses their lack of human connection as an excuse to be a jerk. I'm of the opinion that he's just an ass. Der Alter Jo supports me in this, and I've found that, as Aspergery as she and I can both be at times, she's a better judge of people than I am.

So, the lesson stands as this: If I'm snippy, then I'm wrong. In other words, if something has pushed me so far over the edge that I'm a careful, cutting bitch, I'm certainly not making the right choice in my response.

However: if I fail to cut you, and instead roll over you like an enormous, pissed-off, subtlety-lacking steamroller, the fault is yours.

Sunday, February 06, 2011

And a question: How come nobody just SINGS the damn NATIONAL ANTHEM any more? It ain't gotta be all bullshit blue-eyed soulsy, okay? Just SING the damn ANTHEM. It's a BRITISH DRINKING SONG. You're not going to make it any less wierd by making every damn line into a trillfest.

Jeezus.

And Christina, young lady, I don't want you coming out of your room until you've washed all that paint off your face.

Saturday, February 05, 2011

I'm not talking about the regular readers of this blog, or the folks who have sent me emails (that I haven't answered yet, thus proving that I, too, suck upon occasion) or sent me presents of sparkly nail polish or shine serum for my buzzcut.

I'm talking about the people out there who have adult kids with cancer or who have adult kids who are married to people with cancer, or who have adult kids who have kids with cancer, who don't make an effort to be involved in those people's survival.

Look, I know it's tough. You don't want to revisit that thing that killed your wife. You don't want to see your child, or your child's child, or your child's love, in pain. It freaks you out and makes you uncomfortable, and it might bring up all the shit that should've been said years ago that never got said.

But for once? This is not about you. This is about somebody that you love, that you nurtured and raised and loved, who is going through motherfucking undiluted hell.

When I got my diagnosis, the first thing that happened was that my sister, who was driving at the time, was calm and cool-headed and sensible. The second thing that happened was that my parents were the same way. The third thing that happened--and here is a lesson for you fuckers--was that every. Single. Person I worked with at Sunnydale? Chipped in to send me a bag of goodies. A couple of 'em drove way out of their way to make sure I got that bag of goodies, at the same time that Abilene Rob was visiting in the middle of the third week of school to make sure I ate and was otherwise nourished.

These are people I work with. They are not related to me in any way. And yet they went out of their collective ways to tell me that they were thinking about me, and show me that they loved me. And you can't do that for your own child? What kind of monster are you?

My family is weird; I'll grant you that without argument. My dad, who is very, very bad indeed when it comes to dealing with the sick and injured, did not come down to Texas for my surgery. Instead, he sent silly emails and small presents he knew would annoy me (that's how we show we love each other in my family; with itch powder) and clippings from various newspapers that he thought I might like. He wasn't physically there, but he was there.

My sister and mother came down, along with Sainted Friend Penny, and all three of them combined to take care of each other and me. They fielded phone calls and drove me to and from appointments (as did Nurse Ames, to whom I owe an unpayable debt), and made me ramen when I didn't feel good, and bought bottles of wine and watched unwatchable movies.

And you fuckers can't do that?

What is with you, anyhow? I mean, yeah, your kid's a grown-up now. But if my coworkers and friends are willing to drop everything, for however long, to either drive me to PET scans or listen to my fears or simply put a hand on my shoulder when I'm terrified of MRI results, why can't you? Where the hell are you people? These are children that are of your fucking flesh. Why are you so selfish?

I am pissed on behalf of my friends, who are losing body parts and lives and time to an awful disease that takes as many forms as there are people on the planet. I'm pissed because I got the good, clean, long end of the stick in terms of my friends and relations, but there are people who are way, way nicer than I am who are getting screwed.

It makes me sad. It makes me angry. It makes me want to get on a plane with this enormous pot of buffalo chili and a huge batch of biriyani and home-made flatbread and make somebody's day.

Why are people so mean? Worse, why are they so neglectful?

Nurse Ames, when I told her I have a re-PET in April, said, "I'm going to take you to that, of course. You're fun when you're on Valium, and we have a date! Every year, fucked-up Jo and Mexican food."

It is not that hard. Ball up, be a man or a woman, get your ovaries or testicles in order, and pull up those sparkly disco pants. Just this once, be a decent fucking human being like the people around me have been. Make your kids grateful in their parents, as I have been grateful for mine.

Or else I am stealing your credit card number so I can put an airline ticket on it and go visit the kid you apparently don't have time for.

Friday, February 04, 2011

I got called to start an IV on the floor where they do chemotherapy and bone marrow transplants. That in itself was unusual, because those nurses are the best at finding tiny, threadlike veins in a dehydrated person and floating an eighteen- or twenty-gauge in for rehydration and transfusion.

The patient was a woman I've known since we were both sixteen. Since I last saw her, five years ago, she'd gotten thinner and more attenuated, and her hair had fallen out and grown back into a sort of default pixie-cut: the hairstyle of the recently afflicted. She'd had breast cancer, the awful aggressive sort that hits women in their mid-thirties, that defies hormones and radiation and chemotherapy and surgery. Lung and liver, bone and brain--she was back for placement of an Ommaya reservoir, a piece of plastic that would let the doctors deliver chemo to the metastatic tumors in her brain, and maybe give her a few more months.

She was one of those real, live, honest-to-God cheerleader types, with long dark hair that she refused to perm. She could buy beer long before the rest of us could, because she looked so much older than eighteen. She was pretty and popular and got a degree in management and married a guy who was successful and handsome and had one child before she was diagnosed. If I was a tiny baby-Edward-Gorey pseudo-Goth in high school, she was something out of a Maxfield Parrish painting.

In 2006, we'd walked down the hall together in the afternoon as she described what radiation was like. Her arm was across my shoulders because really, she wasn't that strong, and mine was around her waist. The conversation turned to science fiction and fantasy novels and Star Trek; it turned out she'd had a geek streak even way back then, but had never let it show.

Now I was digging around in her forearm, looking for something that would let her nurse run a couple of units of blood and a couple of sixes of FFP and maybe a liter of fluids. She was talking about how much she had to clear up before she died. She knew that the chemo to her brain might last her through April or May, but after that it was all up.

"It's sort of like, when I got diagnosed, I got thrown into a pit," she said, "and all this time, I've been living in the pit, watching other people come and go. It's dark, but you get used to the dark after a while. The hard thing is seeing other people leave. They're standing on the edge of the pit, yelling at me to stay strong and to fight, but they really don't know what it's like."

I looked up. "You're saying what I've been thinking," I said, "except my metaphor was a swimming pool."

"What am I going to tell my daughter?" she asked. "I've gone from living with cancer to dying of it, and I feel like I ought to apologize."

I sat for a minute. "I have no fucking idea," I finally said, remembering another attenuated, pixie-cut patient who'd asked the same question. "I have no idea. Kids like to think their parents are immortal. I'm not sure there's anything you could say."

"Parents like to think that their kids will do better than they did," she said, "Except now I wonder if maybe this is something that'll come back to hit my daughter, too."

I thought of Lara, whose blog has the header, "Like Mother, Like Daughter."

"Goddamned if I know," I said. "All I know is that dying is just as hard work as birthing or living. If you feel like you ought to apologize, you probably ought to do it now."

"Yeah," she replied, referencing a Zenna Henderson book I'd lent her back when she first came in, "that bridge is getting higher every day."

Y'all up north of the border are probably laughing at the panic that three inches of ice and double that amount of snow has caused down here in That Place Where The Stars At Night Are Big And Bright, but holy crapping monkeys, people, this is bad.

See, we can handle heat. Heat's no problem: you set up cooling centers for folks without air conditioning, you get your roofing crew out early in the morning and late in the day, and you don't go outside without a reason. Heat makes the roads buckle, but it generally doesn't cause them to get slippery. Heat sends people to the emergency room with dehydration, but it won't cause 'em to lose toes and fingers. Ambulances can still run when the temperature's hovering around 108F and the humidity is near 80%.

But we have no snowplows. (Well, I lie: the county where I work has one. The county where I live has none.) Three inches of ice on the roads means that trucks lay down sand and ice melt, the ice melts a bit....and then everything refreezes overnight because there's no way to clear it off the roads. Tuesday night, when this all started, it took me a little over an hour to get home. Last night, after two days of freezing and thawing, it took me over two hours. I drove home on a solid, two-inch-thick slab of mostly-smooth ice.

An ambulance crew coming from way northeast of us took something like four hours to go fifteen miles in this mess--with a critically-ill patient in the box.

Copters? Not flying today. Fire trucks can sort-of make it to where they need to go, but I did see one off in the ditch last night on my way home. The poor police are doing the best they can at blocking off the more treacherous roads, but a lot of their cars are getting stuck, too. Snow tires and chains do jack on ice when it's nine degrees out.

Friends and neighbors, this is how bad it is to move around in an area unprepared for frozen precipitation: Last night, after an hour of skating up and down hills and over bridges, I gave up saying "shit shit shitshitshit you moron what the hell do you think you're doing" to other drivers and just started singing "WHEEE! WHEEEEEEE! YAHOOOOO!" every time I slid. Which was often. And I know how to drive in bad weather.

There are upsides: It's unbelievably quiet. The snow (which just started falling again at a rate of about two inches an hour jeebus grits) is awfully pretty. Max enjoys running around and sliding outside in the yard. Nobody expects you to dress up or be anywhere on time. I can lie around on the couch without guilt. Attila the Trainer has cancelled her appointments for the weekend.

But honestly? I live in Texas primarily to avoid this sort of thing. I don't like having to chip two inches of solid ice off the side of my car at 0400 in subzero windchills just so I can drive forty miles to work at a place that won't even lend me a bed for the night should I decide not to try it again the next day. I get tired of looking like Large Marge ("Worst accident I ever seen!") on my way to work. And my feet are cold.

Oh, well. It's past time for breakfast. I'm going to head out and spear a couple of ptarmigan, or maybe an arctic rabbit or a polar bear, and then make pancakes.

Wednesday, February 02, 2011

Today was Day Two of SNOTORIOUS B.I.G. up in Yeehawton, and boy are we feeling it. Everything from Big Tex to the Canadian border is apparently under sixteen feet of snow, mammoths are roaming, and people have resorted to spearing the weak and elderly for food.

In all seriousness, I am worried about Abilene Rob. (You out there? You okay?) A patient's family member tried to drive today from Abilene to Dallas and, after eight hours (it's normally a three-hour trip), gave up and got a hotel.

But I am alive and well and warm, and Max got into his hated doghouse and did okay today in the cold, and there is wine.

And today, for the first time since surgery, I swallowed normally.

I was standing in the med room in the CCU, very thirsty. I got a glass of water from the tap, put it to my lips, and slugged back half of it in three big swallows without thinking. Up to now, swallowing has been a six-step process that requires thought and concentration. You have no idea how frustrating that is when you're really, *really* thirsty.

"Wait a second," I thought, "I think I just drank that water right down."

So I tried it again. And it worked.

For the rest of the day, I drank water for the pure pleasure of being able to drink without thinking about it. Then I remembered the pure pleasure of having a really full bladder. I think I've been chronically dehydrated since October 21st.

I wanted to keep this to myself as a secret, hug-it-to-my-chest happiness, but dammit, I've shared all the crap with you guys; you deserve the good stuff, too.

I can swallow again. You don't realize how much you miss it until you can't do it.